Study raises questions about elderly, prescription drugs

Charles Ornstein and Tracy Weber |
10/24/2013, 5 a.m.

The report does not tackle two of the most fraught issues in prescribing today: the use of narcotic painkillers and anti-psychotics, especially to treat dementia in the elderly.

Morden said she was surprised to find that, in some regions, large percentages of patients were getting discretionary drugs that were moderately beneficial, like those for acid reflux — and not getting the ones that could save their lives, like the beta blockers or cholesterol-lowering drugs.

“What are we doing?” she said. “It’s surprising to me that we can use so much of our energy to pursue medications that give us far less in terms of health. I worry that it’s coming at the cost of getting the effective medications.”

People in some regions of the country are healthier than in others. But Morden said that does not explain the wide variations her group found in so many different categories of drugs. That may be a signal that patients are not being adequately informed about the risks, benefits and costs of the drugs, she said. Doctors also may be unaware of how different their practices are from the peers in other parts of the country.

Overall, researchers found that the elderly in Miami fill more prescriptions than anywhere else. On average Miami area patients got nearly 63 per person, including refills, in 2010, compared to a national average of 49. Seniors in Miami also had the highest average spending on prescriptions that year $4,738 compared to $2,670 nationally.

In the report, Morden and her co-authors encourage policymakers to seek ways of reducing geographic variation in the way medications are prescribed. They also urge patients to ask their doctors about whether a drug is truly needed for them.

The Dartmouth group has previously examined how costs and use of services in the Medicare program differ markedly across the country. They note that some of the highest-spending regions in terms of drug costs were also among the highest users of other types of medical services.